Healthcare Provider Details

I. General information

NPI: 1467509315
Provider Name (Legal Business Name): KIMBERLY PLOURDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HARTSVILLE PIKE
GALLATIN TN
37066-2400
US

IV. Provider business mailing address

P.O. BOX 8080
GALLATIN TN
37066-8080
US

V. Phone/Fax

Practice location:
  • Phone: 615-328-5750
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number41549
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41549
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: